Comparison of Rehabilitation Characteristics Among High, Average, and Low Performers on Return-to-Sport Testing in Athletes After ACL Reconstruction.

Abstract

Background: Athletes who undergo an anterior cruciate ligament (ACL) reconstruction (ACLR) typically follow supervised rehabilitation before returning to sport. Return-to-sport (RTS) readiness is partially determined by RTS testing. It is not known how characteristics of the supervised rehabilitation episode of care relate to performance on RTS testing.

Purpose: To compare high, average, and low performers on RTS testing among athletes after ACLR in regard to characteristics of their rehabilitation episode of care.

Study design: Case-control study; Level of evidence 3.

Methods: Data from 262 athletes after ACLR (age 20.7 ± 6.7 years; 131 females) who underwent supervised rehabilitation and elective RTS testing were analyzed. Demographic data including the ACL Return-to-Sport Inventory (ACL-RSI) were gathered. RTS testing data included triple-hop symmetry, single-leg vertical jump symmetry, and an assessment of a repeated change-of-direction task for time, the Lower Extremity Functional Test. Athletes were classified as high or low performers if they were in the top (high performers) or bottom quartile (low performers) of at least 2 of the 3 performance measures. Episode of care characteristics included total supervised rehabilitation encounters, episode length, number of unique rehabilitation providers, and frequency of encounters in each quartile. Analyses of covariance with Bonferroni corrections were performed to assess between-group differences with age and sex as covariates.

Results: Of the 262 athletes analyzed, 52 were classified as high performers and 46 were classified as low performers. Compared with high performers, low performers had a lower frequency of rehabilitation encounters in the third quartile (-0.39 visits per week; 95% CI, -0.60 to -0.18; P < .01) and fourth quartile (-0.34 visits per week; 95% CI, -0.54 to -0.14; P < .01). Compared with average performers, low performers had a lower frequency of rehabilitation encounters in the third quartile (-0.20 visits per week; 95% CI, -0.36 to -0.03; P = .04). The ACL-RSI score of the high performers was higher than that of average performers (+10.65; 95% CI, 4.17 to 17.12; P < .01) and low performers (+14.82; 95% CI, 6.70 to 22.95; P < .01).

Conclusion: Athletes who performed well on RTS tests after ACLR had a significantly higher frequency of rehabilitation encounters during the second half of their rehabilitation episode. Supervised care during the later stages of rehabilitation may have contributed to the more favorable outcomes on RTS tests. Clinicians and patients should consider the timing and distribution of rehabilitation encounters when creating and modifying a plan of care.